The COMFORT Scale.In 1992 Ambuel and colleagues presented a nonintrusive method of assessing distress in mechanically ventilated patients in pediatric ICUs,called the COMFORT scale,in which eight factors-six behavioral and two physiologic-were assessed.Others later analyzed the appropriateness of using this scale for assessing sedation and determined cut-off scores for optimal and inadequate sedation in children. In 1996 we undertook a randomized,controlled trial of 158 infants and toddlers up to three years of age in the pediatric surgical ICU at Sophia's
Children's Hospital；the study was designed to validate the use of the COMFORT scale in assessing postoperative pain in infants. To this end,we adapted the scale
by adding an item-“crying”-that would help us assess patients who were not mechanically ventilated.